Study Participants Participants were adult male and non-pregnant female outpatients ages 18-65 with one or more of the following cardiovascular risk factors: hypertension (blood pressure ≥ 140/90 or current treatment for hypertension); dyslipidemia (total cholesterol > 220 mg/dL + LDL cholesterol > 130 mg/dL, or current use of lipid-lowering medications); or controlled type 2 diabetes mellitus (glycated hemoglobin < 8.0 % with or without medication). Subjects with a history of coronary artery disease (any history of myocardial infarction or coronary revascularization) were also eligible for participation. Subjects were excluded if they had a history of congestive heart failure (any classification), unstable angina or acute coronary syndrome within the last 30 days, uncontrolled hypertension (blood pressure ≥ 170/100 mm/Hg), type 1 diabetes mellitus, uncontrolled type 2 diabetes mellitus (HbA1C ≥ 8.0%), history of gastrointestinal disease or surgery affecting absorption, peripheral arterial disease, diagnosis of active cancer (excluding squamous cell or basal cell skin cancer), current use of long-acting nitrate compounds such as isosorbide dinitrate or nitroglycerin, recent change in any medications (last 30 days), active plan to change diet or exercise patterns, history of hypersensitivity to any compound in the intervention or placebo, or history of intolerance to nitrates.